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目的:评价乙状结肠直肠膀胱术和回肠新膀胱术治疗膀胱肿瘤的疗效。方法:对64例行膀胱全切尿流改道患者,根据适应证的不同分别行乙状结肠直肠膀胱术(n=33)和回肠新膀胱术(n=31)治疗。术后跟踪随访平均30个月(3~60个月),并对手术情况及随访资料进行比较。结果:乙状结肠直肠膀胱术手术时间为(3·8±0·8)h,术中出血量为(400±146)mL;贮尿囊容量(495±165)mL;回肠新膀胱术手术时间(7·0±1·5)h,术中出血量(750±213)mL,贮尿囊容量(525±125)mL,两组比较差异均具有显著性(P<0·05)。乙状结肠直肠膀胱术后1例发生尿失禁,4例代谢性酸中毒,1例左肾积水,1例尿液返流。回肠新膀胱术术后7例发生尿失禁,5例代谢性酸中毒,3例肾积水,4例尿液返流。结论:两种术式均达到大容量、低压、高顺应性的要求。回肠新膀胱具有经尿道原位排尿的特点,最易为患者所接受。乙状结肠直肠膀胱术手术时间短,出血量少,操作简便,对肠管扰动小、术后尿控、排空满意,且手术适应证相对较广。
OBJECTIVE: To evaluate the efficacy of sigmoidorectal cancer and ileal neobladder in the treatment of bladder cancer. Methods: Sixty-four patients undergoing bladder resection of urinary diversion were treated with sigmoid colon and rectocele (n = 33) and ileal neo-bladder surgery (n = 31) according to different indications. The follow-up was followed up for an average of 30 months (range, 3 to 60 months). The operative status and follow-up data were compared. Results: The duration of sigmoid colon-rectovagne was (3.8 ± 0.8) h, the blood loss was (400 ± 146) mL, the volume of reservoirs was (495 ± 165) mL, the time of neo-bladder surgery (P <0.05). There was significant difference between the two groups (P <0.05). The blood loss in operation was (750 ± 213) mL and the volume of urine storage was (525 ± 125) mL. One case of sigmoid rectum bladder incontinence, four cases of metabolic acidosis, one case of left hydronephrosis, and one case of urinary reflux. Urinary incontinence occurred in 7 cases of ileal neo-bladder surgery, 5 cases of metabolic acidosis, 3 cases of hydronephrosis, 4 cases of urinary reflux. Conclusion: The two surgical procedures have reached the requirements of large capacity, low pressure, high compliance. The new ileal bladder has the characteristics of transurethral urination in situ, the most easy for patients to accept. The sigmoidorectal surgery has the advantages of short operation time, less bleeding, simple operation, small disturbance to the intestine, postoperative urinary control, emptying, and a relatively wide range of surgical indications.